Allergic Living » fish allergyhttp://allergicliving.com
The magazine for those living with food allergies, celiac disease, asthma and pollen allergies.Tue, 03 Mar 2015 18:40:08 +0000en-UShourly1http://wordpress.org/?v=3.8.1Is It Safe For Those With Shellfish Allergies To Consume Sea Salt?http://allergicliving.com/2014/05/05/is-it-safe-for-those-with-shellfish-allergies-to-consume-sea-salt/
http://allergicliving.com/2014/05/05/is-it-safe-for-those-with-shellfish-allergies-to-consume-sea-salt/#commentsMon, 05 May 2014 20:15:02 +0000http://allergicliving.com/?p=25033Q: I’m a chef and often serve food to allergic customers. Is it safe for those with shellfish allergies to consume sea salt? I’ve read that it can contain a microscopic type of shellfish.

Dr. Sicherer: Sea salt differs from table salt primarily because sea salt is evaporated from seawater rather than refined from mined salt. Sea salt may come from different sources and these have different color, mouth feel and texture based on granule size and mineral content.

I believe what you’ve read about are the microscopic animals called marine copepods, which are related to shrimp. These minuscule animals are permitted in unfiltered public drinking water in areas that have excellent natural sources that require no filtrations.

No harmful effects have been related to these creatures, which would be consumed by large numbers of individuals drinking public water (e.g. in New York City).

Copepods likely have shellfish-allergy relevant proteins, but the amount of exposure should be too low to trigger allergic reactions.

The dilution effect of water would presumably reduce exposure and while concentrating seawater to create sea salt may theoretically concentrate copepods if they are present, I could locate no studies or scientific reports to verify allergic reactions to sea salt or unfiltered water attributable to copepods. The risk appears to be extremely low.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

]]>http://allergicliving.com/2014/05/05/is-it-safe-for-those-with-shellfish-allergies-to-consume-sea-salt/feed/0Can I Be Allergic to All Fish But One?http://allergicliving.com/2013/09/16/allergic-to-all-fish-but-one/
http://allergicliving.com/2013/09/16/allergic-to-all-fish-but-one/#commentsMon, 16 Sep 2013 16:40:04 +0000http://allergicliving.com/?p=19347

Photo: Thinkstock

Q: My girlfriend has confirmed allergies to tuna, anchovies, shrimp, crab, clams and mussels. However, she can eat salmon with no issues.

Does it make sense that she could be able to eat salmon but still be allergic to virtually every other creature of the sea? If so, could she consider trying squid or escargot?

Dr. Waserman: It is confusing, but it does make sense. The foods you mentioned can be broken down into two groups: fish and shellfish. The main allergens in these groups are different, and allergy can develop to either group and, in rare cases, to both. It is also possible to be allergic to some but not all types of fish or shellfish within each group. For example, there are those who can eat crab but not lobster, while others can eat salmon but not cod. There is, however, a high degree of cross-reactivity within each of these food groups, and some may need to avoid all forms of fish or shellfish.

Given your girlfriend’s high degree of reactivity to many members of the fish and shellfish family, I would not recommend experimentation with any new “creature of the sea” until she is assessed by her allergist.

She also needs to be careful eating salmon when dining out. There is a risk of cross-contamination if her salmon is prepared on equipment (for example, a frying pan) where other fish or shellfish are prepared.

Dr. Susan Waserman is an allergist and Professor of Medicine in the Division of Allergy and Clinical Immunology at McMaster University in Hamilton, Ont. She is also a past president of the Canadian Society of Allergy and Clinical Immunology.

]]>http://allergicliving.com/2013/09/16/allergic-to-all-fish-but-one/feed/0All About Fish, Shellfish Allergieshttp://allergicliving.com/2010/10/04/all-about-fish-shellfish-allergies/
http://allergicliving.com/2010/10/04/all-about-fish-shellfish-allergies/#commentsMon, 04 Oct 2010 15:34:06 +0000http://allergicliving.com/?p=8469It’s an experience that has puzzled thousands of seafood lovers across Canada and around the world: You’ve eaten fish and shellfish all of your life with no ill effects, and then one day, you’re eating some tasty tidbit from the sea – maybe some jumbo shrimp, some butter-drenched lobster, or some fresh-caught salmon – and suddenly, you don’t feel so good.

Maybe you feel like you’re going to be sick to your stomach, or feel your throat tightening and your lungs beginning to wheeze. You may feel flushed and hot as your face turns beet red. Maybe you break into hives from head to toe, or feel like you’re going to pass out as your heart takes off like a bullet train.

Chances are that you are having an allergic reaction to seafood – the most common culprits in the allergy world.

What’s The Problem?

Seafood can be divided into two groups: shellfish and fish. Shrimp is behind most of the reactions, and shellfish as a group – which can include oysters, mussels, scallops, squid, crab, snails and many more – tends to be more problematic than finned fish. (In one survey by FAAN and Mount Sinai researchers, two per cent of respondents reported a shellfish allergy, whereas just 0.4 per cent reported an allergy to fish.)

Symptoms of a reaction to seafood can include flushing and swelling in the face, mouth and throat; digestive tract symptoms such as nausea and diarrhea; itching and hives; difficulty breathing; lightheadedness or faintness; a sudden drop in blood pressure and a rapid heartbeat.

In severe cases, a person may experience anaphylactic shock, a reaction that includes one or more of the body’s systems and can result in cardiac arrest and death.

Widespread Incidence

A whopping 2.3 per cent of Americans are allergic to some form of seafood, whether it’s fish, crustaceans or mollusks. In Canada, 1.69 per cent of people are allergic to shellfish and 0.48 per cent are allergic to fish. What’s more, a 15-nation study showed the incidence is similarly high right around the world.
See: Seafood Allergy Statistics

Because of its high incidence, Health Canada has named both shellfish and fish “priority food allergens”, which means tougher labeling rules for Canadian manufacturers. Other regions, including the United States and Europe, have also included seafood on their lists of top allergens.
See: Label Aware

It’s a Grown-Up Thing

What’s different about seafood allergies is that they are largely an adult phenomenon. In Canada, 1.69 per cent of adults have shellfish allergy, compared to just 0.5 per cent of children. According to the FAAN-Mount Sinai survey, 2.8 per cent of adults in the United States reported a seafood allergy, as compared with just 0.6 percent of children.

This can be especially problematic, since most adults are accustomed to eating seafood, so when they react, it doesn’t seem to make sense to them. Often they dismiss earlier, less severe reactions as food poisoning or simply “something they ate”; but then they get a tough lesson in science as the allergy grows more severe and the reactions more extreme.

Unfortunately, once an adult develops a shellfish allergy, he or she likely has that allergy for life.

A quick test: what’s the most widespread food allergy in North America today?

If you answered ‘peanut’, that’s incorrect. But you could hardly be blamed given that legume’s notoriety. The right answer is seafood – from fish to crustaceans and mollusks.

At a time when every “must-try” new restaurant is an over-priced sushi bar, an astounding 2.3 per cent of Americans are now allergic to one form or another of seafood. (There is no such specific Canadian data, but general rates of allergic prevalence are considered comparable.)

If that incidence comes as a surprise, however, you’re in good company. Even the researchers who surveyed 5,500 households for the Food Allergy & Anaphylaxis Network (now FARE) in Virginia and the Mount Sinai School of Medicine in New York to arrive at this finding were taken aback.

“We said, ‘can this be real?”‘ recalls Anne Munoz-Furlong, founder and former CEO of FAAN and co-author of the resulting seafood prevalence study published in 2004. “We learned that shellfish and fish is about double the incidence of peanut and tree nut combined.”

In fact, the researchers reviewed the data to see if something was, well, fishy. But it wasn’t. Those who were accepted as allergic in the detailed phone survey “were very clear in their answers and the symptoms were very clear,” says Munoz-Furlong. Supporting those findings was a 15-nation study that showed similarly high levels of seafood allergies.

Shrimp was the most common cause of reactions in the FAAN-Mount Sinai survey. In fact, shellfish as a group – crustaceans and mollusks – proved by far the larger cul­prit, with 2 per cent of survey participants reporting shellfish allergy while 0.4 per cent reported fish.

Another eye-opening finding was that this is largely an adult phenomenon. The survey found 2.8 per cent of adults were seafood allergic compared to 0.6 per cent of children. And that can be one of the most difficult aspects of this condition – since it strikes grownups, who’ve been eating for years as they pleased, they often don’t know what hit them.

What happened to Chris Oleson is not uncommon. The 41-year-old is a self‑described “beach guy” who lives in San Francisco and grew up surfing on the California coast.

One day in 2002, he was with his wife Julia at an upscale sushi restaurant. He’d eaten about five or six very tasty” items from the trays on offer, when a waiter approached. “Sir, your ears are turning red. You may want to get that checked out,”‘ Oleson recalls him saying.

Oleson was suddenly rather feverish and unwell, but he wasn’t that concerned. He and his wife just thought he was com­ing down with a bug and had better get home. Oleson has asthma, and on the drive home an attack started coming on. He was also feeling woozy when Julia said, “you know, you’ve got hives.”

By the time they got through the door at a nearby hos­pital, Oleson was staggering. He lost consciousness on a stretcher. “The last thing I remember was they took my blood pressure and said, ‘this guy’s lucky to be alive’ It was very, very low.”

Oleson saw an allergist for allergy skin and blood tests. He turns out to be part of a minority allergic to both shellfish and finned fish (though his shellfish sensitivity measures much higher).

What he realizes today is that this was actually his second seafood reaction. The first came eight months earlier, at a gathering at his in-laws home in Washington state. The so-called “bad flu” he suffered had overcome him right after a dinner of fresh cooked lobster. While he’d eaten crab all his life, that was his first experience eating lobster.

Those who suddenly find themselves allergic wonder: what causes a seafood allergy to switch on in adulthood?

“No one knows for sure,” says Dr. Scott Sicherer, an allergist and associate professor of medicine at Mount Sinai. Sicherer is a co-author of the U.S. prevalence survey and also has written a two-part review of seafood studies from around the world, published in 2006 in UpToDate, an evidence-based clinical information resource for physicians.

While there are no firm answers as to “why,” he identifies a couple of theories. Scientists are intrigued that the main allergen in shellfish, the muscle protein tropomyosin, is very similar to the tropomyosin found in dust mites and cockroaches, highly allergenic pests.

“One theory would be air exposure to these [insect] proteins could drive a shell­fish allergy,” says Sicherer, which might explain studies in which orthodox Jews, who had never eaten a crustacean, tested positive to shellfish.

But like most allergy theories, this one has holes: how to resolve, as Sicherer notes, that “the vast majority of people testing positive to dust mites are fine eating shellfish?”

Next: Fatalities and What to Do

]]>http://allergicliving.com/2010/09/10/out-of-its-shell/feed/0What’s New: Boiling Off Shrimp’s Potencyhttp://allergicliving.com/2010/09/02/whats-new-boiling-off-shrimps-potency/
http://allergicliving.com/2010/09/02/whats-new-boiling-off-shrimps-potency/#commentsThu, 02 Sep 2010 14:09:28 +0000http://allergicliving.ds566.alentus.com/?p=4983Researchers in China and Louisiana have tested and compared raw and boiled proteins of a common type of shrimp. They were excited to find that boiling shrimp for 10 minutes reduces the allergenicity of the protein called tropomyosin, the main allergen in shellfish.

There would still be protein traces and no one is suggesting that the one in 50 Americans who are allergic to shellfish (the family that includes shrimp, lobster, clams and crab) begins tucking into a well-boiled chowder.

But the study, published in the Journal of Food Science in January, shows promising results on the possibility of lowering the allergenic properties of shrimp. Tropomyosin (TM) is the main allergen in seafood, including shrimp.

Food scientists have found that boiling shrimp for 10 minutes seems to reduce the allergenic potency. Researchers compared raw and boiled shrimp that had been ground and freeze-dried and found that the boiled shrimp had fewer allergenic properties than its raw counterpart.

While a far cry from a cure, lead researcher Guang Ming Liu believes the findings are a step in the right direction: “Understanding the allergenic properties of shrimp as affected by the cooking process is critical for shrimp allergic individuals.”

- That 30 to 50 per cent of those with an allergy to one of the seafood groups will react to more than one type of fish or shellfish.

However, you can also be allergic to just one type of fish or shellfish. It’s even possible to be allergic to just one type of shrimp.

- That it is common for people to be allergic to more than one shellfish. Sicherer finds up to 80 per cent who are allergic to one crustacean may be sensitized to others, and “40 per cent may react upon ingestion.”

In one study reviewed, blood samples from nine patients with shrimp anaphylaxis reacted to the proteins of 13 crustaceans and mollusks. As well, he finds between 10 and 15 per cent allergic not only to other crustaceans, but to mollusks as well.

- That the risk of reacting to more than one fish is high. Sicherer suggests to speaking to your allergist: “Your allergist may take into consideration the severity of your allergy, test results, and dietary preferences to determine what it is you can and can not eat.”

- That about 50 per cent with a mollusk allergy react to more than one mollusk.

Between shellfish and fish …

According to Sicherer, only about 10 per cent react to both, which have quite different key allergenic proteins (tropomyosin in shellfish; parvalbumin in fish).

Remember, however, that there may be cross-contact between the two groups at grocery seafood counters or in restaurants.

Sources:UpToDate 2006; interview Dr. Scott Sicherer

]]>http://allergicliving.com/2010/09/02/fast-facts-about-seafood-allergies/feed/0Signs and Symptoms of Food Allergyhttp://allergicliving.com/2010/08/30/signs-and-symptoms-of-food-allergy/
http://allergicliving.com/2010/08/30/signs-and-symptoms-of-food-allergy/#commentsMon, 30 Aug 2010 14:25:10 +0000http://allergicliving.ds566.alentus.com/?p=3282Do you sometimes feel sick to your stomach not long after eating? Have you noticed a pattern in the types of food you eat when this occurs? Perhaps you have experienced unexplained skin rashes (known as hives) or vomiting or diarrhea?

Does your child refuse to eat a certain food, or complain that it makes his “tongue hurt”? These could be signs of a food allergy, and should be taken seriously.

It is common for the symptoms of food allergy to vary by individual – and from reaction to reaction in the same person. Not everyone will get all the symptoms, which range greatly in severity from mild to severe (and even fatal): your throat may feel tight on one exposure to your allergen or you may get itchy hives on your skin and vomiting with the next.

The Range of Symptoms

-Tingling in the mouth
-Swelling of the tongue and throat / feeling of throat tightness
-Itchy skin, hives or skin redness
-Abdominal cramps
-Vomiting or diarrhea
-Breathing difficulty, wheezing
-Faintness due to a sudden drop in blood pressure

Anaphylaxis

Anaphylaxis is the severe form of allergic reaction. It involves one or more of the body’s symptoms; for example, the gastrointestinal tract, the respiratory tract, the skin and the cardiovascular system. A person experiencing anaphylaxis often has difficulty breathing, and the person could lose consciousness. Anaphylaxis puts a person at risk of death.

Anaphylactic reactions can come on quickly, and it’s impossible to know when a reaction will become severe. It’s important that people with food allergies are prepared for a reaction by always carrying an epinephrine auto-injector (e.g. EpiPen or Auvi-Q or Allerject).

Experts recommend using epinephrine early if a person known to be at risk of anaphylaxis begins to show signs of allergy symptoms – don’t wait until the symptoms worsen, as it may become to difficult put a halt to the reaction once it’s in progress.

Clarke and her colleagues surveyed close to 10,000 Canadians in the Surveying Canadians to Access the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) study. They found that 3.2 per cent were allergic to one or more of peanuts, tree nuts, shellfish, fish and sesame. Of those, “at most, only 38.7 per cent reported receiving epinephrine,” while having a moderate to severe reaction, says Clarke.

It’s not clear whether these individuals had auto-injectors and simply didn’t use them, or if epinephrine wasn’t available to them. Either way, Clarke told Allergic Living that the numbers concerning.

“We certainly know that there is a problem here in the proper management, because one would like to see that almost everybody who is reporting a moderate to severe reaction would receive the epinephrine.”

Clarke says her team has dug into the data a little further to look at what type of people are likely to carry an auto-injector, but results of that analysis are not yet available.

The SCAAALAR study, which is partially funded by the allergy research network AllerGen, also looked at attitudes towards food labeling, particularly precautionary statements on food packages (such as “may contain” advisories), and attitudes of general population toward risk of food allergy in the context of environmental health risks. Results will be available in the coming months.

Highlights from SCAAALAR study

Allergies in the Canadian population

Peanut

Children

1.68%

Adult

0.71%

All

0.93%

Tree Nut

Children

1.59%

Adult

1%

All

1.14%

Shellfish

Children

0.5%

Adult

1.69%

All

1.42

Fish

Children

0.18%

Adult

0.56%

All

0.48%

Sesame

Children

0.23%

Adult

0.05%

All

0.09%

Published in the June 2010 issue of the Journal of Allergy and Clinical Immunology. View here.

Situation: There’s a friend at work you’ve often had lunch with. Lately, he’s decided it’s funny to tell the waiter “just bring her some water – she’s allergic to everything else.”

How to handle: Before your next midday meal with Don Rickles, prepare a sarcastic retort along the lines of “while my incredibly sensitive friend finds the idea of me doing a faceplant in my soup hilarious, I think I’ll just tell you about my life-threatening allergies instead.” If that doesn’t get the point across, ditch buddy boy and find a new lunchmate; preferably one who doesn’t find your serious health condition such a thigh-slapper.

Situation: Your new in-laws are desperate to have you two over for dinner, but you’re highly allergic to cats, and their beloved Mr. Tinkles is definitely the lord of the manor.

How to handle: You might as well be honest. Tell them about your allergy, and suggest that a meal in their beautiful garden would be a better option. (Hey, kissing up to the in-laws early is a good idea, especially if you’re planning to have kids.) It doesn’t hurt to lay some ground rules early either, in preparation for all those years and years of visits ahead. Ask if Mr. Tinkles could be confined to one room while you’re there, and suggest that, while you know your mother-in-law’s house is always spotless, maybe running the vacuum quickly before you arrive would, however, help your breathing. Bring a treat for the ball of allergenic fluff to show you don’t hate cats, really. And get your husband to agree to a late arrival and early departure, lest he bear the brunt of your coughing, snoring and wheezing all night.

Situation: A close friend asks you to be in her wedding party, but option two on the reception dinner menu is salmon – and you’re at risk of anaphylaxis to fish.

How to handle: Tell her that you’re willing to wear the seafoam green taffeta bridesmaid dress, but you’ll have to put your foot down when it comes to your ability to breathe unassisted. Speak
to the caterer ahead of time: can he assure that if you pick one of the other options, there will be no cross-contamination in the kitchen? If in doubt, bring your own meal and ask the caterer to have it served along with the others. Give a trusted friend the task of overseeing the handling of your food in the kitchen.If even a good whiff of fish has you reaching for the Epi or Twinject, tell the bride that, while you will be thrilled to precede her down the aisle, you’ll have to arrive at the reception after all fishy scraps have been cleared.

Situation: You’re out at a restaurant on a first date with an attractive, interesting fellow, who orders something you’re allergic to. Later, he leans in for a goodnight kiss.

How to handle: First of all, a kiss on the first date? OK, I’m old- fashioned, but a handshake or a hug should suffice. If your heart is already aflutter, best to be upfront. Calmly tell Dreamboat that he’s eaten something you’re allergic to, and that it’s just not safe for you to lock lips so soon after he’s eaten. Thank him for a wonderful evening and suggest getting together soon for a non-food date.

First published in Allergic Living magazine.
(c) Copyright AGW Publishing Inc.